<form action="" method="post">
<table cellspacing="0" cellpadding="2" border="0" class="mTop10" >
 

<tr>
<td width="210" valign="middle" align="right">
<div><b>Họ và tên: </b></div>
</td>
<td valign="top">
<input type="text" name="HoVaTen" id="HoVaTen" value="<? echo $_POST['HoVaTen']?>" style="border: 1px solid #CCCCCC;border-radius: 3px;height: 24px; padding:0 5px;width:260px" /><b style="color: red;font-weight: bold;"> * </b>
</td>
</tr>

<tr>
<td width="210" valign="middle" align="right">
<div><b>Email: </b></div>
</td>
<td valign="top">
<input type="text" name="Email" id="Email" value="<? echo $_POST['Email']?>" style="border: 1px solid #CCCCCC;border-radius: 3px;height: 24px; padding:0 5px;width:260px" /><b style="color: red;font-weight: bold;"> * </b>
</td>
</tr>
 

<tr>
<td width="210" valign="middle" align="right">
<div><b>Nội dung: </b></div>
</td>
<td valign="top">
<textarea cols="70" rows="5" name="NoiDung" id="NoiDung" style="border: 1px solid #CCCCCC;border-radius: 3px;  padding:0 5px; "><? echo $_POST['NoiDung']?></textarea><b style="color: red;font-weight: bold;"> * </b>
</td>
</tr>
<tr><td valign="top" style="width: 25%; padding-top: 7px; text-align: right;">
                        <strong> Nhập mã xác nhận:</strong></td>
                       <td style="height: 25px;" align="left">

                                        <img src="library/captcha/captcha.php" id="captcha" />
                                     <a onclick="document.getElementById('captcha').src='library/captcha/captcha.php?'+Math.random();" id="change-image">   <img alt="" src="images/ref.gif" width="26" height="25" /></a><br />
                                     <input type="text" name="captcha" id="captcha-form" value="<? echo $_POST['captcha']?>" style="border: 1px solid #CCCCCC;border-radius: 3px;height: 24px; padding:0 5px;width:260px" /><b style="color: red;font-weight: bold;"> * </b>
                                     </td>
                    </tr>
<tr>
<td valign="top" align="right">
</td>
<td valign="top" align="left">
<div style="font-size: 12px;margin-top:5px"><i> Ô có dấu (<b style="color: red;font-weight: bold;"> * </b>) là bắt buộc </i></div>
</td>
</tr>
<tr><td><br /></td></tr>

<tr>
<td valign="top" align="right">
</td>
<td valign="top" align="left">
<input type="submit" value="Gửi" class="button" />
</td>
</tr>

</table></form>